Treatment for Scratchy Throat with Cough
For a scratchy throat with cough, start with honey and lemon mixtures as your first-line treatment, followed by dextromethorphan 30-60 mg if additional relief is needed, and add menthol lozenges or vapor for symptomatic relief. 1, 2
Initial Self-Care Approach
Most scratchy throats with cough are caused by viral respiratory infections and will resolve without medical intervention. 3
Key first-line treatments:
- Honey and lemon mixtures are the simplest, cheapest, and often effective first approach 1
- Adequate hydration to thin secretions 1
- Paracetamol (acetaminophen) for discomfort 3
- Simple voluntary cough suppression may be sufficient in many cases 1
Pharmacologic Options
Dextromethorphan (Preferred Antitussive)
- Dextromethorphan is the recommended first-line antitussive due to superior safety profile compared to opioid alternatives 2, 4
- Effective dose is 30-60 mg for maximum cough reflex suppression with prolonged effect 1, 2
- Standard over-the-counter dosing is often subtherapeutic 2
- FDA-approved to temporarily relieve cough due to minor throat and bronchial irritation 4
Menthol Preparations
- Provides acute, short-lived cough suppression through cold and menthol sensitive receptors 1, 2
- Available as menthol crystals, lozenges, or vapor 3
- Useful for quick but brief relief 2
Second-Line: Sedating Antihistamines
- First-generation antihistamines (like chlorpheniramine) can suppress cough 1, 5
- Particularly suitable for nocturnal cough due to sedating effects 2, 5
What NOT to Use
Avoid codeine or pholcodine - they have no greater efficacy than dextromethorphan but carry a much greater adverse side effect profile. 1, 2
Antibiotics are not helpful - even if you're bringing up phlegm, most short-term coughs are viral and antibiotics won't help. 3
When to Seek Medical Attention
See a doctor if you have: 3, 2
- Coughing up blood
- Breathlessness
- Prolonged fever and feeling unwell
- Pre-existing conditions (COPD, heart disease, diabetes, asthma)
- Recent hospitalization
- Symptoms persisting for more than 3 weeks
Additional Practical Advice
- Stop smoking - it worsens cough and respiratory symptoms 3, 1
- Practice good cough hygiene: use handkerchief and wash hands to prevent spreading infection 3
- Most coughs are self-limiting and will resolve without specific treatment 1
Common Pitfalls to Avoid
- Using subtherapeutic doses of dextromethorphan (less than 30 mg) that won't provide adequate relief 2
- Prescribing codeine-based antitussives which have no efficacy advantage but increased side effects 2
- Be cautious with higher doses of dextromethorphan as some preparations contain other ingredients like paracetamol 1